Aortic graft-enteric and paraprosthetic-enteric fistulas.

Gastrointestinal hemorrhage is often a late manifestation of an aortoenteric fistula. Warning symptoms may include back or abdominal pain, fever, anemia, hematochezia, or melena. This entity results from erosion of the gastrointestinal tract by an adjacent vascular prosthesis. A paraprosthetic-enteric fistula represents a step in the formation of a true aortoenteric communication. Aggressive diagnostic studies, including endoscopy, aortography, barium contrast, computerized axial tomography, and radionuclide scanning, may allow earlier diagnosis and correction than have occurred in the past. Treatment should include graft excision, closure of the bowel defect, appropriate antibiotic therapy, and extraanatomic revascularization if collateral flow is not adequate. Our experience with 21 patients has illustrated the high mortality rate (74 percent) when operative treatment is delayed until massive hemorrhage occurs.